Hem/Onc Exam 1

What are the 5 qualities that would make a drug hazardous?

carcinogenic, teratogenic, fertility impairment, organ toxicity at doses <10 mg/day, genotoxicity

How many of the 5 qualities does it take for a drug to be considered hazardous?

1

What can result from acute exposures to hazardous drugs?

skin or eye irritation, flu-like symptoms, headache

What can result from chronic exposure to hazardous drugs?

fetal abnormalities, loss of fertility, secondary cancers

What is the most common route of exposure to hazardous drugs?

contaminated surfaces

Which anticoagulant is considered hazardous?

warfarin

Which antifungal is considered hazardous?

fluconazole

Which SSRI is considered hazardous?

paroxetine

Which anticonvulsant is considered hazardous?

phenytoin

Which benzo is considered hazardous?

temazepam

Which GLP-1 is considered hazardous?

liraglutide

Which hazardous drugs are considered low risk?

finasteride, misoprostol

What type of room pressure is required by USP 800 for hazardous drug compounding and storing?

negative pressure

What hood air flow is required by USP 800 for the compounding of sterile hazardous drugs?

vertical flow

What PPE does the USP 800 require for compounding sterile hazardous drugs?

double glove or chemo rated, impermeable gowns, double shoe covers, respiratory protection

a drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of the HD or vapor concentrations outside the system

closed system drug transfer device (CSTD)

What is the most commonly used closed system drug transfer device?

Equashield

USP 800 requires that hazardous drugs be stored _______ other inventory and in a ______ room

away from; negative pressure

How should pharmacy staff handle HD inventory per USP 800?

open in segregated space and wear gloves

USP 800 requires that hazardous drug packages and storage areas bear

distinctive labels for special handling precautions

What does PRONTO stand for?

patient, regimen/dose, organ function/labs, numbers, toxicities, order verification

What is PRONTO used for?

it is a method used for order verification of hazardous chemotherapy drug products/regimens

What is reviewed during the patient portion of PRONTO?

review chart, check patient’s performance status, and access line status

How do you assess a chemo patient’s performance status?

ECOG status from 0-5

Which ECOG status (0-5): fully active, able to carry on all pre-disease performance w/o restriction?

0

Which ECOG status (0-5): restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature

1

Which ECOG status (0-5): ambulatory and capable of all selfcare, but unable to carry out any work activities; up and about more than 50% of waking hours

2

Which ECOG status (0-5): capable of only limited selfcare, confined to bed or chair more than 50% of waking hours

3

Which ECOG status (0-5): completely disabled, cannot carry on selfcare; totally confined to bed or chair

4

Which ECOG status (0-5): dead

5

Which type of line access is preferred in chemo patients?

central line

What is the definition of a chemotherapy cycle?

how frequent the regiment is repeated

What is the definition of a chemotherapy day?

the day of each cycle the medication is given

What is the correct sequence chemotherapy should be given?

vesicant, irritant, non-vesicant

T/F: when determining sequence of chemotherapy less stable agents should be given first

True

What is the primary responsibility at the R step in PRONTO?

safety

What are some labs we may want to check in the 1st O step of PRONTO?

CBC, electrolytes, renal & liver function, urinalysis, ECHO/EKG

How is chemotherapy typically dosed?

by BSA or mg/m²

How is carboplatin dosed?

by AUC

BSA =

square root of [(ht in cm x wt in kg)/3600]

What is the dose rounding allowance for chemotherapy agents in most institutions?

5-10%

What are some toxicities to consider in the T step of PRONTO?

N/V, infusion related rxns, neutropenia, tumor lysis syndrome

What is involved in the last step of PRONTO?

comparing chemotherapy order, label and product

the inadvertent instillation or leakage of a cytotoxic drug into the perivascular space during infusion

extravasation

What are some examples of chemotherapy vesicants?

anthracyclines, taxanes, vinca alkaloids

Irritant vs Vesicant: may induce a local inflammatory response

irritant

Irritant vs Vesicant: severe necrosis, erythema and blistering of skin

vesicant

Irritant vs Vesicant: blood return remains intact

irritant

Irritant vs Vesicant: blood return is absent

vesicant

Irritant vs Vesicant: may take up to 6-12 hrs for symptoms to appear

vesicant

Irritant vs Vesicant: vein may be tender or have burning/erythema

irritant

What are some strategies to prevent extravasation with IV chemotherapy agents?

use central line access, educate patient on s/s, check for blood flow throughout admin, and given bolus doses over 5-10 mins

What are some strategies to mitigate if extravasation occurs?

stop infusion, aspirate drug via IV cannula, remove catheter, elevate and immobilize limb, apply cold, administer antidote, mark around site, monitor for 24hrs and up to 2 wks

What should you NOT do if extravasation occurs with IV chemotherapy?

flush the line

When should warm be applied when extravasation occurs with IV chemotherapy?

only with Vinca alkaloids

Which extravasation antidote is useful for anthracyclines and given IV?

dexrazoxane

What is the MOA of dexrazoxane?

prevent free radical formation and reduce oxidative stress

Which extravasation antidote is useful for anthracyclines and cisplatin and given topically?

dimethyl sulfoxide (DMSO)

What is the MOA of dimethyl sulfoxide (DMSO)?

neutralizes free radicals and promotes absorption of vesicant

Which extravasation antidote is useful for vinca alkaloids or taxanes and given SC?

hyaluronidase

What is the MOA of hyaluronidase?

accelerates local connective tissue breakdown and absorption

Which extravasation antidote is useful for cisplatin and given SC?

sodium thiosulfate

What is the MOA of sodium thiosulfate?

binds and neutralizes vesicant

What are the two different types of statistical curves used in oncology drug clinical trials?

kaplan-meier curve and waterfall plot

What is the gold standard endpoint for oncology drug clinical trials?

overall survival

What are the advantages of overall survival as a endpoint in oncology?

primary endpoint, easily measurable, definitive results, eliminates researcher bias

What are the disadvantages of overall survival as endpoint in oncology?

death not related to cancer, quality of life, cross-over in tx groups

a general term for an increase in the number of the cells of an organ or tissue causing it to increase in size

hyperplasia

an abnormality in the appearance of cells indicative of an early step towards transformation into a neoplasia

dysplasia

represents a final transformation of a dysplastic cell to cancer, though the cancer remains local and has not metastasized

in situ carcinoma

cancer which has invaded beyond the original tissue layer and is also able to spread to other parts of the body

invasive cancer

What are the steps of oncogenesis?

hyperplasia, dysplasia, in situ carcinoma, invasive cancer

What are the two ways cancer is classified?

by histology type or primary site

tissue in which the cancer originates =

histology type

location in the body where the cancer first developed =

primary site

cancer of epithelial cells

carcinoma

cancer of connective tissue (muscle & bones)

sarcoma

cancer of plasma cells of bone marrow

myeloma

cancer of bone marrow

leukemia

cancer of lymphatic tissue

lymphoma

chemotherapy delivered before the main treatment, helps reduce the size of a tumor or kill cancer cells that have spread

neoadjuvant

How are neoadjuvant chemotherapy treatments used?

used to downstage patients w/ malignant tumors making primary tumors and metastases resectable

chemotherapy delivered after primary treatment which attempts to elimiate micrometastasis

adjuvant

How are adjuvant chemotherapy treatments used?

given to prevent a possible cancer recurrence

chemotherapy determined to have the best probability of treating a given cancer also called standard therapy

first line chemotherapy

chemotherapy that is given if a disease has not responded or reoccurred after first line chemotherapy; also referred as salvage therapy

palliative

elimination of all known tumors

curative

Intrinsic or acquired chemotherapy drug resistance: resistance exists before drug treatment

intrinsic

Intrinsic or acquired chemotherapy drug resistance: induced resistance after therapy

acquired

What does cancer staging describe?

the extent or spread of disease at the time of diagnosis

What are the two different types of cancer staging?

summary and TNM

Cancer staging Summary 1 =

in situ is early cancer that is present only in the layer of cells in which it began

Cancer staging summary 2 =

localized is cancer that is limited to the organ in which it began, w/o evidence of spread

cancer staging summary 3 =

regional is cancer that has spread beyond the original site to nearby lymph nodes or organs and tissues

cancer staging summary 4 =

distant (metastatic) is cancer that has spread from the primary site to distant organs or distant lymph nodes

T in TNM cancer staging

size of tumor and/or whether it has grown to involve nearby areas

N in TNM cancer staging

the absence or presence of regional lymph node involvement

M in TNM cancer staging

absence or presence of distant metastases

What are the two racial/ethnic disparities observed across oncological studies?

lack of racial/ethic information and overrepresentation of caucasian/white samples

What is an example of a cancer that is purely caused my germline mutations?

APC